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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2021; 12(04): 242-244
DOI: 10.1055/s-0041-1741388
Endoscopy Video

Combined EUS LAMS and Percutaneous Fully Covered SEMS-Guided Direct Endoscopic Necrosectomy (e-DEN + p-DEN) for Walled-Off Pancreatic Necrosis with Paracolic Extension

Ashish Gandhi 
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
,
Mangesh Borkar
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
,
Harsh Bapaye 
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
2   Department of Medicine, Byramjee Jeejeebhoy Medical College, Pune, Maharashtra, India
,
Rajendra Pujari
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
,
Amol Bapaye 
1   Shivanand Desai Centre for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
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Abstract

Management of infected lesser sac walled-off pancreatic necrosis (WOPN) is technically challenging and involves endoscopic ultrasound (EUS)-guided transmural drainage using either lumen-apposing metal stent (LAMS) or multiple plastic stents as the standard approach. A step-up approach—drainage followed by additional direct endoscopic necrosectomy (DEN) whenever required—has been a standard recommendation. Collections extending to the paracolic gutter are difficult to manage endoscopically and often require additional surgical intervention. In this video case, we describe a combined approach using EUS-guided LAMS and percutaneous fully covered self-expandable metal stent-guided DEN (e-DEN + p-DEN) for successful management of an infected lesser sac WOPN with paracolic extension.

Keywords

walled-off pancreatic necrosis - WON - WOPN - percutaneous direct endoscopic necrosectomy - direct endoscopic necrosectomy - DEN - DEN - p-DEN

Financial Disclosure

None.


Consent

Written informed consent was obtained from patient for publication of this report.




Publikationsverlauf

Artikel online veröffentlicht:
18. Januar 2022

© 2022. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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